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Our Plan

Your OSSTF Benefits Plan

Your OSSTF Benefits Plan was designed by learning what benefits matter the most to OSSTF members and designing one plan that fits best for all of us. Everyone has the same benefits across Ontario so it’s fair and equitable.

Eligible members can make claims during the benefits year for the period of time they are an eligible member. Go to OTIP’s secure member website to make a claim once you are enrolled.

Here’s a snapshot of the benefits you receive (PDF) as an eligible OSSTF member. For a full breakdown of benefits, go to OTIP’s secure member website.

It’s important you also know the breakdown of your member contributions. View the Member Share Illustration (PDF).

Eligibility.

Who is eligible and important information for new hires and new leaves

The following individuals are eligible for the OSSTF Benefits Plan:

  • Contract teachers and support staff
  • Eligible long term occasional (LTO) teachers
  • Eligible retirees

LTO Teachers: If an LTO Teacher bargaining unit previously had eligibility for coverage under their collective agreement, eligible LTO members can participate in the OSSTF Benefits Plan.

Note: If participation in the benefits for eligible LTOs was on a 100% member paid basis under previous collective agreements, this arrangement continues under the OSSTF Benefits Plan.

Effective Date of Coverage for Eligible Members: The effective date of coverage for eligible members who enrol in the OSSTF Benefits Plan is the same as their date of eligibility.

A number of reasons, including the format of the data, when a change is reported or processed, etc., may cause delays in the processing of coverage for some members. Your coverage is retroactive to your eligibility date. Working closely with OTIP, some system enhancements were put in place and OSSTF Benefits is confident that processing time and the number of retroactive adjustments will be reduced.

Be sure to retain your receipts. All eligible claims incurred on or after the effective date of coverage can be submitted for reimbursement under the OSSTF Benefits Plan. Premiums and member contributions towards optional life, accidental death and dismemberment, health and/or dental benefits will be payable retroactively as well.

Unpaid/Non-statutory Leaves

If you are on an unpaid/non-statutory leave, you are still eligible for the continuation of your benefits coverage. Benefits premiums are 100% member-paid. To learn more, contact OTIP Benefits Services at 1-866-783-6847.

Note: Changes to your FTE status or work status may not be reflected immediately in OTIP’s benefits administrative system and may take 5-10 business days for the information to be processed, dependent on when the information was received, payroll schedules, etc. If you choose to continue benefits coverage, premiums will be due from the leave start date and eligible claims incurred on or after the leave start date will be processed. Be sure to retain your receipts.

Outstanding Retroactive Premium Payments

If you have large outstanding retroactive premium payments due to the retroactive data adjustments, please contact Donna Morrison at donna.morrison@osstfbenefits.ca to investigate payment options.

Retirees: Eligible retirees will be eligible to participate in the OSSTF Benefits Plan if they are were covered in a Board-owned retiree plan at the transition date for active members of their bargaining unit into the OSSTF Benefits Plan and still have coverage in a board-owned retiree plan.

The transition of the coverage for eligible retirees into the OSSTF Benefits Plan is being worked on. All involved parties are evaluating current arrangements in board plans and details will be shared once further information is available.

How do I submit a claim?

Claims can be submitted by:

Appealing a Claim

OSSTF ELHT has worked closely with OTIP to design the OSSTF Benefits Plan. The plan provides comprehensive coverage provisions, however, there may be occasions when a claim is partially or wholly denied and you may be unclear, or may disagree, with the reason for the claim denial. To cover these types of situations, an appeal process is built into the OSSTF Benefits Plan where you may appeal a claim denial by following the process outlined below:

Step 1 – Clarification and Further Information

OSSTF ELHT encourages members to review the Benefits Booklet on the OTIP member site for clarification of the provisions of the OSSTF Benefits Program. The booklet is posted under My Benefits for your access. You can also call into OTIP Benefits Services at 1-866-783-6847 to discuss your claim with an OTIP Benefits Services representative. He/she can assist you in understanding the OSSTF Benefits Plan and why certain benefits may not be covered and/or explain additional information that may be needed to have the claim further reviewed.

If this does not answer your questions or you still disagree with the handling of the claim, you should request that your concerns are escalated to an OTIP Benefits Services Technical Specialist. He/she will investigate the claim, review the plan design, and consult with senior technical staff, the insurance carrier and underwriting as needed, to ensure that the claim is processed correctly.

If these actions do not resolve your concern, you may officially file an appeal.

Step 2 – OTIP Appeal Process

  • Appeal requests must be submitted in writing and must outline the reason(s) you believe the claim should be paid. Appeals can be sent:
    • By email to BenefitAppeal@otip.com
    • By fax to 1-866-404-6847
    • By mail to:
      OTIP Health & Dental Appeal Committee
      PO Box 218
      Waterloo ON, N2J 3Z9
  • The appeal will be reviewed by the OTIP Appeal Committee, who has the authority to approve claims on a one time, without prejudice basis up to a limit of $5,000 per claim.
  • If you are not satisfied with the decision of the OTIP Appeal Committee, you may ask to move the appeal to the OSSTF ELHT Appeal Committee for their review and decision.

Step 3 – OSSTF ELHT Appeal Committee

  • The OTIP Appeal Committee will present the details of your appeal on a confidential anonymous basis to the OSSTF ELHT Appeal Committee for their review and decision. The OSSTF ELHT Appeal Committee may approve the appeal on a one time, without prejudice basis, or maintain the denial.
  • The OSSTF ELHT Appeal Committee will report their decision to OTIP and the OTIP Benefits Services Department will communicate the appeal outcome to you.

Note: Appeals must be in writing, the claim must be a minimum value of $150 and the appeal must be initiated within 90 days of the initial claim settlement date for health or dental and within one year of the settlement date of a life claim.